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ID:48028098
大小:5.01 MB
页数:57页
时间:2020-01-10
《0115脑疝分类及影像学表现图解.ppt》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、图解脑疝北京天坛医院神经内科杜万良(reflexhammer)脑疝是指在颅内压增高的情况下,脑组织通过某些脑池向压力相对较低的部位移位的结果,即脑组织由其原来正常的位置而进入了一个异常的位置。脑疝的类型:a.大脑镰疝:一侧大脑半球占位病变可使同侧扣带回经大脑镰下缘疝入对侧,胼胝体受压下移。小脑幕切迹疝b.前疝:也称颞叶沟回疝,是颞叶沟回疝于脚间池及环池的前部;②后疝:颞叶内侧部疝于四叠体池及环池的后部;f.小脑幕切迹上疝:后颅凹占位病变时,小脑上蚓部可向上疝入小脑幕切迹的四叠体池。c.中心疝:幕
2、上压力增高,致使大脑深部结构及脑干纵轴牵张移位。d.颅外疝:脑组织通过颅外缺损疝出。e.枕骨大孔疝:后颅凹占位病变时,可致小脑扁桃体疝入枕骨大孔。g.蝶骨嵴疝:颅前凹和颅中凹的占位病变,由于病变部压力相对高一些,则额眶回可越过蝶骨嵴进入颅中凹,可颞叶前部挤向颅前凹。示意图a)subfalcial(cingulate)herniation;镰下疝b)uncalherniation;钩疝c)downward(central,transtentorial)herniation;下行性小脑幕疝d)ext
3、ernalherniation;颅外疝e)tonsillarherniation.扁桃体疝f)ascendingtranstentorialherniation(reversedtentorial)上行性小脑幕疝g)sphenoidherniation蝶骨嵴疝类型脑疝部位命名别名疝入脑组织命名1.大脑镰下疝扣带回疝2.小脑天幕疝前疝后疝小脑幕切迹疝、小脑幕下降疝脚间池疝环池疝,四叠体疝颞叶钩回疝海马回疝3.小脑幕孔中心疝间脑4.小脑幕孔上疝小脑幕上疝小脑蚓部疝5.枕骨大孔疝小脑扁桃体疝示意图解剖
4、关系解剖关系FQcMb3vTOSyCClvFPOSpCClvss解剖关系FTCesPd4thVFTMbCesThesuprasellarcistern&thequadrigeminalcisternTheleftandcenterimagesshowthesuprasellarcistern.Itsanteriorbordersareformedbythefrontallobes(F).Itslateralbordersareformedbytheuncus(U)ofthetemporallob
5、es.Theleftimageshowsthe5-pointedstarappearanceofthesuprasellarcisternwheretheposteriorborderisformedbythepons(Po).Theblackarrowpointstothefourthventricle.Thecenterimageshowsahighercutwherethesuprasellarcisternhasa6-pointedstarappearancesincetheposter
6、iorborderisformedbythecerebralpeduncles(P)whichhaveacentralcleft.Therightimageshowsthequadrigeminalcistern(blackarrow).Notethe"baby'sbottom"appearanceofitsanteriorborder.WhenICPisincreased,thequadrigeminalcisternspaceiscompressedorobliterated.Thesupr
7、asellarcistern&thequadrigeminalcistern.ThemidlinesagittalMRIscanshowsthelevelsoftheaxialdiagrams.Thequadrigeminalcisternislocatedabove(anteriorto)the"Q"inthehighestcutshown(number9).Theanteriorborderofthequadrigeminalcisternisformedbythesuperiorcoll
8、iculi(c).Image8(lowercut)alsoshowsthequadrigeminalcistern.Inthiscase,itsanteriorborderisformedbytheinferiorcolliculi(c).Thisgivestheanteriorborderofthequadrigeminalcisterntheappearanceofa"baby'sbottom".Thequadrigeminalplateiscomprisedofthesuperiorand
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